Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

• Published in: Cardiovascular and interventional radiology Vol. 43; no. 8; pp. 1148 - 1155
• Main Authors: Winzer, Robert, Fedders, Dieter, Backes, Moritz, Ittermann, Till, Gründling, Matthias, Mensel, Birger, Held, Hanns-Christoph, Kromrey, Marie-Luise, Weitz, Jürgen, Hoffmann, Ralf-Thorsten, Bülow, Robin, Kühn, Jens-Peter
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2020; Springer Nature B.V
• Subjects: Aged; Arterial Interventions; Arteries; Cardiology; Catecholamines; Clinical Investigation; Demographics; Demography; Female; Humans; Imaging; Infusions, Intra-Arterial; Intravenous therapy; Ischemia; Kaplan-Meier Estimate; Lactic acid; Male; Medicine; Medicine & Public Health; Mesenteric Ischemia - drug therapy; Mortality; Nuclear Medicine; Papaverine - administration & dosage; Papaverine - therapeutic use; Patients; pH effects; Radiology; Retrospective Studies; Splanchnic artery; Survival; Survival analysis; Survival Rate; Therapy; Treatment Outcome; Ultrasound; Vasodilator Agents - administration & dosage; Vasodilator Agents - therapeutic use; Patient outcome assessment; Papaverine; Infusion therapy; Non-occlusive mesenteric ischemia; Mesenteric ischemia
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-020-02515-4

Purpose To investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach. Methods From 2013 to 2019 , patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan–Meier survival analysis and Cox regression, respectively. Results A total of 66 patients with NOMI were included, with n  = 35 treated interventionally (21 males, mean age 67.7 ± 12.3 years) and n  = 31 treated conservatively (18 females, mean age 71.6 ± 9.6 years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12/35 survived) and the conservative group (96.8%; 1/31 survived) (hazard ratio 2.44; P  = 0.005). Thresholds associated with a worse outcome of interventional therapy are > 7.68 mmol/l for lactate, < 7.31 for pH and <  − 4.55 for base excess. Conclusion Local intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome. Level of Evidence Level III.